Study Shows Benefits of Statins Beyond Lowering Cholesterol

June 2, 2017—The European Society of Cardiology (ESC) announced that a study presented at EuroCMR 2017 demonstrated that statins are associated with improved heart structure and function. The benefits were above and beyond the cholesterol-lowering effect of statins. EuroCMR 2017, the annual cardiovascular magnetic resonance (CMR) conference of the European Association of Cardiovascular Imaging, was held May 25–2017 in Prague, Czech Republic.

In the ESC press release, the study's lead author Nay Aung, MD, commented, “Statins are primarily used to lower cholesterol. They are highly effective in preventing cardiovascular events in patients who have had a heart attack or are at risk of heart disease.” Dr. Aung continued, “Statins have other beneficial, noncholesterol-lowering effects. They can improve the function of the blood vessels, reduce inflammation, and stabilize fatty plaques in the blood vessels. Studies in mice and small studies in humans have shown that statins also reduce the thickness of heart muscle, but this needed to be confirmed in a larger study.” Dr. Aung is a cardiologist and Wellcome Trust research fellow with William Harvey Research Institute at Queen Mary University of London, United Kingdom.

As summarized by the ESC, this study investigated the association between statins and heart structure and function and included 4,622 people without cardiovascular disease from the United Kingdom Biobank, a large community-based cohort study. CMR imaging was used to measure left and right ventricular volumes and left ventricular mass. Medical records and a self-reporting questionnaire were used to obtain information on statin use.

The relationship between statin use and heart structure and function was assessed using multiple regression to adjust for potential confounders that can have an effect on the heart, such as ethnicity, gender, age, and body mass index (BMI).

Approximately 17% of study participants were taking statins. Those taking statins were older, had higher BMI and blood pressure, and were more likely to have diabetes and hypertension. Dr. Aung noted, “This was not surprising because we prescribe statins to patients at high risk of heart disease, and these are all known risk factors.”

The investigators found that patients taking statins had a 2.4% lower left ventricular mass and lower left and right ventricular volumes. Dr. Aung stated, “People using statins were less likely to have a thickened heart muscle (left ventricular hypertrophy) and less likely to have a large heart chamber. Having a thick, large heart is a strong predictor of future heart attack, heart failure, or stroke, and taking statins appears to reverse the negative changes in the heart which, in turn, could lower the risk of adverse outcomes.” He added, “It is important to note that in our study, the people taking statins were at higher risk of having heart problems than those not using statins, yet they still had positive heart remodeling compared to the healthier control group.”

To explain how statins might reduce the heart's thickness and volume, Dr. Aung noted that statins have been shown to reduce oxidative stress and dampen the production of growth factors that stimulate cell growth. Statins also increase the production of nitric oxide by the cells lining the blood vessels, leading to vasodilatation, improved blood flow, lower blood pressure, and lower stress on the heart, which is less likely to become hypertrophied.

As noted in the ESC announcement, although the findings raise the issue of extending statin prescriptions to anyone aged > 40 years, Dr. Aung advised against this. He stated, “There are clear guidelines on who should receive statins. There is debate about whether we should lower the bar and the question is when do you stop. What we found is that for patients already taking statins, there are beneficial effects beyond cholesterol lowering and that’s a good thing. But instead of a blanket prescription, we need to identify people most likely to benefit—ie, personalized medicine.”

“A dual approach should be considered to identify people who will benefit most from statins. That means looking at not only clinical risk factors such as smoking and high blood pressure, but also genetic (hereditary) factors which can predict individuals’ response to statins. This is an area of growing interest and one that we are also investigating in our lab with our collaborators,” concluded Dr. Aung in the ESC press release.

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